Customised Antenatal Growth Chart - National Women's Hospital ...

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Customised Antenatal Growth Chart
Document Type Guideline
Function(s) Clinical Service Delivery
Activity & Sub-Activity Clinical Practice
Health Service Group (HSG) Women’s Health
Departments affected Maternity
Staff affected All clinicians in Maternity
Key words Antenatal, growth, chart, fundus, gestation, birth
weight,
Author – role only Maternal Fetal Medicine Consultant, Women’s Health
Owner (see ownership structure) Clinical Director of Obstetrics, Women’s Health
Edited by Clinical Policy Advisor
Date first published August 2005
Date this version published October 2011
Date of next scheduled review October 2014
Unique Identifier NMP200/SSM/058
Contents
1. Purpose of guideline
2. Guideline management principles & goals
3. Accessing customised antenatal growth charts
4. Fundal height measurement procedure
5. Supporting evidence
6. Associated ADHB documents
7. Disclaimer
8. Corrections and amendments
Customised Antenatal Growth Chart Oct11.doc
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1. Purpose of guideline
This guideline establishes the correct procedure for measurement of fundal height
within Auckland District Health Board (ADHB) and for use of a customised growth chart
to aid interpretation of fundal height and ultrasound estimated fetal weight.
2. Guideline management principles & goals
Customised Antenatal Growth Chart Oct11.doc
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Each pregnant woman should be provided with a customised growth chart that
estimates the expected growth in fundal height for her individual pregnancy. Fundal
height measurements should be recorded from 24 weeks onwards and should not be
plotted more frequently than fortnightly.
Women over 100kg
For women >100 Kg, fundal height measurements are not reliable but estimated fetal
weight measurements from growth scans should be plotted. Growth scans in women >
100kg should be performed if clinical assessment is not possible because of body
habitus (which is often the case). Suggested gestations for ultrasound growth
assessment are 30 and 36 weeks for women > 100kg when SGA cannot be excluded
clinically.
Fundal height > 90 th centile
When fundal height is >90 th centile it is important to ensure that appropriate diabetes
testing has been performed and if there is concern re polyhydramnios a scan should be
performed. There are no other evidence based interventions for management of the
baby that is suspected to be LGA and therefore referral is not usually indicated. Note
the primary purpose of the customised antenatal growth charts is to increase antenatal
detection of SGA babies.
See flowchart: Diabetes Screening
Women at high risk of SGA
Women at high risk of SGA e.g. previous SGA baby

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3. Accessing customised antenatal growth charts
At booking interview, measure the woman’s weight, height, record her ethnicity, LMP
and EDD. Also record the weight, gestation at delivery and sex of any previous babies
From within the ADHB network:
i. Press the start menu on your computer and select programs
ii. From the programs menu select GROW
iii. Select “enable macros”
If outside ADHB, there are a number of ways to access the GROW programme, for
further information go to www.gestation.net.
i. Complete the data requested
ii. The programme will calculate the woman’s BMI
iii. Enter birth weight, infant sex and gestation at delivery for any previous
babies and a birth weight centile will be generated for them
iv. The customised chart will then appear on the screen with a graph of the
optimal fundal height and estimated fetal weight measurements for the
current pregnancy
v. Enter the woman’s estimated delivery date
vi. Press print
vii. Add chart to the woman’s clinical record
Note if a previous infant had a birth weight

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4. Fundal height measurement procedure
1. Mother semi-recumbent, with bladder empty.
2. Palpate to determine fundus with two hands.
3. Secure tape with hand at top of fundus.
Customised Antenatal Growth Chart Oct11.doc
• Explain the procedure to the
mother and gain verbal consent
• Wash hands
• Have a non-elastic tape measure
to hand
• Ensure the mother is comfortable
in a semi-recumbent position, with
an empty bladder
• Expose enough of the abdomen to
allow a thorough examination
• Ensure the abdomen is soft (not
contracting)
• Perform abdominal palpation to
enable accurate identification of
the uterine fundus.
• Use the tape measure with the
centimetres on the underside to
reduce bias
• Secure the tape measure at the
fundus with one hand
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4. Measure to top of symphysis pubis.
Customised Antenatal Growth Chart Oct11.doc
• Measure from the top of the fundus
to the top of the symphysis pubis
• The tape measure should stay in
contact with the skin
5. Measure along longitudinal axis of uterus, note metric measurement.
6. Plot on customised chart, record in notes
•
• Measure along the longitudinal
axis without correcting to the
abdominal midline
• Measure only once
• Record the metric measurement
and plot it on the growth chart
and record the fundal height
measurement in the antenatal
records
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5. Supporting evidence
A UK study showed an increased detection of small for gestational age (SGA) babies
from 29% in the control group to 48% in the group with a customised growth chart. An
audit from the community clinic at National Women’s health found that 60% of women
with a customised growth chart had their SGA babies recognised before birth
compared with 10% detection in mothers without a customised growth chart .The
gestation related optimal weight (GROW) programme can now be applied to New
Zealand ethnic groups. It is likely that there will be less intervention in babies that are
physiologically small such as some Indian and Asian babies.
www.perinatal.nhs.uk/
www.gestation.net
Gardosi J, Francis A. Controlled trial of fundal height measurement plotted on
customised antenatal growth charts. B J Obstet Gynae 1999; 106:309-17
McCowan L, Stewart AW, Francis A, Gardosi J. A customised birth weight centile
calculator developed for a New Zealand population. Aust NZ J Obstet Gynaecol. 2004;
44: 428-431
McCowan L, Stewart AW. Term birth weight centiles for babies from New Zealand’s
main ethnic groups. Aust NZ J Obstet Gynaecol. 2004; 44: 432-435
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6. Associated ADHB documents
Protocol for IUGR Management in Day Assessment Unit
Referral – Maternal Fetal Medicine
Flowchart: Diabetes Screening
7. Disclaimer
No guideline can cover all variations required for specific circumstances. It is the
responsibility of the health care practitioners using this ADHB guideline to adapt it for
safe use within their own institution, recognise the need for specialist help, and call for
it without delay, when an individual patient falls outside of the boundaries of this
guideline.
8. Corrections and amendments
Customised Antenatal Growth Chart Oct11.doc
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The next scheduled review of this document is as per the document classification table
(page 1). However, if the reader notices any errors or believes that the document
should be reviewed before the scheduled date, they should contact the owner or the
Clinical Policy Advisor without delay.
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